Peripheral arterial disease (PAD) is a systemic disease with significant morbidity and mortality. A substantial number of patients with PAD have infrapopliteal disease; however, diagnosis based solely on symptoms and ankle-brachial index can lead to delayed or missed opportunities to provide improved quality of life and limb salvage, and potentially reduce mortality. Advances in techniques and devices, and modification of classification systems have shown that an endovascular approach should be the primary therapeutic option for critical limb ischemia resulting from infrapopliteal disease.